This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and management. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, initial treatment focuses on immobilization using rigid collars, braces, halo traction, or halo vests.
3. Common injuries include fractures of C1-C2 and the odontoid process. Type II odontoid fractures are prone to displacement and non-union, so may need open reduction and fusion
This document provides information on pelvic fractures, including:
- Pelvic fractures account for about 5% of skeletal injuries and most commonly occur in road traffic accidents.
- The pelvic ring is composed of the sacrum and two innominate bones joined by ligaments to provide stability.
- Pelvic fractures can result from lateral compression, anteroposterior compression, or vertical shear forces.
- Treatment may involve non-operative management for minor injuries or operative stabilization using external or internal fixation for more severe injuries.
This document discusses proximal humerus fractures, including:
- They are common in older patients and often result from low-energy falls.
- Classification systems include the AO/OTA system and Neer system, which categorizes fractures as one, two, three, or four-part based on displacement of fragments.
- Nondisplaced or minimally displaced one-part fractures are most common and are typically treated non-operatively with rest and sling immobilization.
This document discusses supracondylar fractures of the humerus, which occur most commonly in children ages 5-10 years old. It describes the anatomy of the elbow joint and mechanisms of injury for supracondylar fractures. The Gartland classification system grades the fractures from non-displaced to severely displaced. Treatment depends on the fracture type, with non-displaced fractures treated conservatively and displaced fractures requiring closed or open reduction with pin fixation. Complications can include vascular injury, nerve injury, compartment syndrome, malunion, and elbow stiffness.
This document discusses Monteggia fractures, which involve a fracture of the ulna bone in the forearm combined with a dislocation of the radial head. It begins with a historical description of the injury and provides details on epidemiology and classifications. Bado's classification system from 1958 divides Monteggia fractures into four main types based on the direction of radial head dislocation and location of the ulna fracture. The document discusses mechanisms of injury, clinical evaluation, radiographic assessment, non-operative and operative management approaches, potential complications, and emphasizes the importance of anatomic reduction and stabilization of both the ulna fracture and radial head dislocation.
Compartment syndrome occurs when increased pressure within a closed muscle compartment reduces blood flow, potentially causing tissue death. It is caused by factors that increase swelling such as fractures. Symptoms include pain disproportionate to the injury that worsens with stretching of muscles. Diagnosis involves measuring compartment pressure. Early fasciotomy, in which fascia is cut to release pressure, can prevent complications if performed within 6-8 hours of onset. Later surgery risks muscle death and contractures.
supracondylar fracture humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow injuries in children, making up approximately 60% of cases. They typically occur as a result of a fall onto an outstretched hand in children aged 5-7 years old. Radiographs are used to classify fractures as non-displaced (Type I), displaced with an intact posterior cortex (Type II), or completely displaced (Type III). Posteromedial displacement is more common than posterolateral. Physical examination focuses on evaluating neurovascular status and detecting any S-shaped deformity, with nerve injuries occurring in up to 16% of cases.
1) Polytrauma refers to multiple injuries that affect multiple body systems and can lead to organ dysfunction or failure. It requires management by a team of surgeons and physicians, including an orthopedic surgeon.
2) The priorities in managing polytrauma are life salvage, limb salvage, and salvaging total function if possible. This involves controlling hemorrhage, treating life-threatening injuries, and splinting fractures while avoiding further injury.
3) Damage control orthopedics focuses on rapidly stabilizing fractures to control bleeding and prevent further tissue injury, while delaying more definitive fixation to avoid exacerbating the body's inflammatory response in critically injured patients.
This document provides information on fractures of the distal end of the radius bone. It discusses the history, incidence, anatomy, classification, diagnosis, and treatment options for these fractures. Distal radius fractures most commonly result from falls on an outstretched hand and occur in three main age groups. Treatment depends on factors like fracture pattern and stability, and may involve closed reduction with casting or surgical options like percutaneous pinning, plating, or external fixation. The goals of treatment are to restore function, alignment, and stability while avoiding complications.
The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
This document discusses cubitus varus, which is a deformity where the forearm is deviated inward at the elbow joint, reducing the normal valgus angle. It describes the causes, types, clinical examination findings, measurements on x-rays, and treatment options. The most common treatment involves corrective osteotomy, with various techniques described such as lateral closing wedge osteotomy, medial open wedge osteotomy, oblique osteotomy, and dome osteotomy. Complications of osteotomy include stiffness, nerve injury, persistent or recurrent deformity, non-union, and skin issues.
Galeazzi fracture-dislocation is a fracture of the distal or middle third of the radius shaft combined with dislocation of the distal radioulnar joint. It most often occurs in males due to indirect trauma from a fall on an outstretched hand with rotation. Radiographs show the radial fracture and dislocation of the distal radioulnar joint. Treatment involves open reduction and internal fixation of the radial fracture with a plate while restoring length and stability of the distal radioulnar joint. The forearm is then immobilized in supination for 4-6 weeks to heal.
Intertrochanteric fractures of the femurRajiv Colaço
The document discusses extracapsular intertrochanteric hip fractures. It describes the anatomy and classification systems for these fractures. Conservative management involves traction but is associated with high complication rates. Internal fixation with devices like the dynamic hip screw or proximal femoral nail is now the standard of care to allow early mobilization. Surgical techniques like closed or open reduction may be used along with supplemental procedures like medial displacement osteotomy in unstable patterns.
Hemiarthroplasty involves replacing the femoral head while retaining the natural acetabulum. It is commonly used to treat fractures of the femoral neck in elderly patients. There are two main types - unipolar, which replaces just the head, and bipolar, which adds an inner bearing. Selection depends on factors like bone quality and joint stability. Cemented stems are generally preferred in patients with poor bone stock, while uncemented can be used if bone is adequate. Positioning and fixation are important to optimize function and stability.
Ankle fractures are common injuries that require careful evaluation to identify bony and soft tissue damage. The ankle is a complex hinge joint supported by ligaments and the tibia, fibula, talus, and deltoid ligament. Classification systems like Lauge-Hansen and Weber are used to characterize fracture patterns and guide management, which may involve closed treatment for stable injuries or surgery to restore ankle anatomy and stability for unstable fractures. Radiographs are important for diagnosis but CT or MRI may be needed to fully evaluate injury extent.
This document discusses radial nerve injury, including its anatomy, causes, clinical presentation, diagnostic workup, and management. It describes the radial nerve's course from the brachial plexus into the arm and forearm. Radial nerve injuries can be caused by fractures, compression, or traction injuries. Clinical examination involves assessing motor function of wrist and finger extensors and sensory function on the back of the hand. Management includes nonsurgical treatment, nerve repair or grafting, and tendon transfers in chronic cases. The goal of treatment is to restore wrist and finger extension through nerve regeneration or reconstruction of function.
Humeral shaft fractures are fractures of the upper arm bone between the shoulder and elbow. They make up 3-5% of all fractures. Most heal with conservative care like splinting or bracing, though some require surgery. Risk of complications is higher with more displaced or open fractures. Treatment depends on fracture type and stability, with options including splinting, bracing, plating, nailing, or external fixation. Potential complications include nonunion, malunion, nerve injuries, and joint stiffness.
This document discusses neck of femur fractures (NOF), also known as hip fractures. It covers the epidemiology, risk factors, anatomy, classification, diagnosis, and treatment of NOF fractures. NOF fractures typically occur in elderly patients from low-energy falls and are associated with osteoporosis, while in younger patients they usually result from high-energy injuries. Treatment depends on factors like the patient's age, health, and fracture classification, and may involve closed or open reduction, fixation with screws or nails, or arthroplasty. Complications can include nonunion, osteonecrosis, fixation failure, dislocation, and increased mortality risk especially in older or less healthy patients.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
Femoral shaft fractures occur in the diaphysis of the femur between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle. They are commonly caused by high-energy trauma in young adults and falls in the elderly. Clinical evaluation involves assessing neurovascular status, associated injuries, and deformity or shortening of the leg. X-rays are used to confirm the diagnosis and classify the fracture. Treatment options include traction, casting, intramedullary nailing, plate fixation, or external fixation depending on the patient's age and the fracture pattern. Complications can include blood loss, nerve injuries, infections, and non-union.
The document discusses various types of cervical spine trauma and injuries that can occur. It describes fractures of the atlas including Jefferson's fracture and posterior arch fractures. Hangman's fractures and teardrop fractures of the axis are also summarized. Odontoid fractures are divided into Types I-III. Vertebral body compression fractures like wedge fractures and burst fractures are mentioned. The document also briefly summarizes clay shoveler's fractures and lamina and transverse process fractures of the cervical spine. Various imaging modalities for evaluating cervical spine injuries are also discussed.
A spinal cord injury can result in permanent impairment if not properly diagnosed and managed. The document defines spinal cord injury and discusses epidemiology, anatomy, pathophysiology, and management. It describes the structure and blood supply of the spine, classification systems for fractures, and associated conditions like spinal and neurogenic shock. Key tracts and myotomes are also outlined.
This document provides information on cervical spine injuries, including:
- Upper cervical injuries involve C1-C2 and lower cervical injuries involve C3-C7.
- Common upper cervical injuries include fractures of the atlas and axis as well as occipital condyle fractures and occipitoatlantal dislocations.
- Lower cervical spine injuries include fractures of the vertebral bodies and posterior elements like the lamina.
- Detailed classifications and treatment recommendations are provided for various cervical fractures and dislocations. Imaging like CT and MRI play an important role in evaluation of these injuries.
Neck of Femur, IT and Subtrochanteric fracture- Dr Sundar Ortho.pptxDr. Sundar Karki
1. The document discusses the anatomy, classification, diagnosis, and treatment of fractures of the neck of femur, intertrochanteric fractures, and subtrochanteric fractures.
2. Key classifications include Garden's classification (based on displacement), Pauwel's classification (based on angle of inclination), and the Russell-Taylor classification for subtrochanteric fractures.
3. Treatment involves internal fixation with multiple screws or dynamic hip screws, hemiarthroplasty or total hip replacement depending on patient age and fracture type. Complications include nonunion, avascular necrosis, malunion, and osteoarthritis.
This document provides information on supracondylar fractures of the humerus, which commonly occur in children between ages 5-8 from falls on an outstretched hand. It describes the anatomy of the elbow joint, types and classifications of supracondylar fractures, clinical features, treatment options including closed or open reduction and K-wire fixation, and complications such as nerve injuries, Volkmann's ischemia, malunion, myositis ossificans, and Volkmann's contracture. Supracondylar fractures can have serious early complications and require prompt diagnosis and treatment to prevent long-term issues.
Rib fractures are commonly caused by blunt chest trauma and are often seen following motor vehicle crashes and falls. While usually not life-threatening on their own, they can indicate more severe underlying injuries to the chest or abdomen. Treatment focuses on pain management to prevent respiratory complications and complications are more common in elderly patients and those with multiple rib fractures.
1) Proximal humerus fractures are common in elderly patients and can be classified using the AO or Neer systems.
2) Nondisplaced fractures are usually treated non-operatively while displaced fractures may require surgical intervention such as open reduction internal fixation, hemiarthroplasty, or reverse total shoulder arthroplasty.
3) Surgical treatment aims to restore anatomy and stability but can increase risks of complications compared to nonoperative treatment. The optimal management of displaced proximal humerus fractures remains controversial.
Capitellar fractures account for a small percentage of elbow fractures and are more common in females. They occur when the capitellum is sheared off in a coronal plane. Diagnosis is made through lateral x-rays showing displacement. CT scans help evaluate fracture patterns. Treatment depends on the Bryan and Morrey classification, ranging from non-operative management for nondisplaced types to open reduction and internal fixation using headless screws for displaced types to achieve anatomic reduction and early motion. Excision is recommended for small articular fragments. Complications include nonunion and avascular necrosis.
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesSean M. Fox
The document provides an overview of commonly encountered pediatric elbow injuries seen in the emergency department setting. It reviews the anatomy and imaging evaluation of pediatric elbow fractures including the supracondylar humerus, radial neck, lateral condyle, and medial epicondyle fractures. Specific radiographic findings that help identify subtle fractures are discussed. Challenges in pediatric elbow imaging related to ossification centers are also covered. The goal is to help emergency physicians accurately diagnose pediatric elbow fractures on radiographs.
This document summarizes information about spinal injuries, including causes, types, symptoms, examination, and treatment. Spinal injuries can cause paralysis and are serious because of potential damage to the spinal cord. The most common causes are falls and vehicle accidents. Injuries are classified by mechanism and may be stable or unstable. Treatment involves emergency stabilization, definitive care like surgery if needed, nursing to prevent complications, and long-term rehabilitation. The goal is to prevent worsening of neurological symptoms and achieve spinal stability.
Clavicle fractures are common injuries, especially in young active individuals. The majority occur in the midshaft region due to its thin bone and lack of muscle protection. Treatment depends on the location and degree of displacement/shortening. Nondisplaced fractures are usually treated nonsurgically with slings or strapping. Displaced fractures may require plate fixation, intramedullary nails, or coracoclavicular ligament repair/reconstruction to achieve union and restore function. Complications can include nonunion, malunion, hardware irritation, and neurovascular injury.
The document discusses injuries to the spine. It covers the epidemiology, anatomy, classification of injuries as stable or unstable, and mechanisms of injury. It then describes specific cervical and thoracolumbar spine injuries, including fractures, dislocations, and treatment approaches which may involve immobilization, traction, or surgery.
Atlantoaxial injuries can cause serious neurologic problems if not properly treated. Rotatory subluxation of C1 on C2 is the most common type and results from trauma or infection that disrupts the transverse atlantal ligament. Anterior subluxation involves displacement of C1 forward on C2 due to ligament disruption or odontoid process abnormalities. Fractures of C1 and C2 can also occur from trauma and require evaluation to assess stability and neurologic involvement. Treatment depends on the specific injury but may involve traction, immobilization, or fusion surgery to prevent further neurologic damage.
This document provides an overview of spinal disorders, including:
1. Traumatic spinal disorders like fractures of the cervical spine (C1-C2), thoracolumbar fractures from compression or flexion, and cervical disc herniations.
2. Treatment approaches depending on the stability and neurological involvement, ranging from immobilization to surgical fixation or decompression.
3. A classification system for cervical fractures like Anderson and D'Alonzo for odontoid fractures.
4. Details on mechanisms, clinical features, investigations, and management of specific fractures.
- Proximal humerus fractures account for up to 45% of all humeral fractures and are classified based on the number of fractured fragments and their displacement.
- Treatment depends on the fracture pattern and patient factors. Undisplaced or minimally displaced fractures are typically treated non-operatively with immobilization followed by rehabilitation. Displaced fractures may require surgical management including closed reduction with pins, plates, nails or prosthetic replacement depending on the severity.
- Four-part fractures and fracture dislocations have a high risk of avascular necrosis due to disruption of the blood supply and often require hemiarthroplasty or reverse total shoulder arthroplasty in elderly patients.
Proximal humerus fractures are common injuries, especially in older patients due to osteoporosis. They can be classified based on the number of bone fragments and degree of displacement. While undisplaced or minimally displaced fractures can often be treated non-operatively with immobilization, more displaced fractures usually require surgery such as open reduction and internal fixation with a locking plate or intramedullary nailing. The goal of both non-operative and operative treatment is to restore the anatomy and allow early range of motion exercises to prevent stiffness.
Cervical Spine Radiograph - MaxilloFacial TraumaHimanshu Soni
This document discusses cervical spine radiography for evaluating maxillofacial trauma. It outlines the indications for cervical spine x-rays, including neck pain, altered mental status, intoxication, focal neurological deficits or complaints, and distracting injuries. The recommended views are a three-view series including cross-table lateral, anteroposterior, and open-mouth odontoid views. Each view is described in detail, focusing on evaluating alignment, bones, cartilage, and soft tissues for abnormalities that could indicate injuries like fractures or dislocations. The document emphasizes that all three views are needed to thoroughly assess the cervical spine following trauma.
This document provides information on fractures of the radius and ulna shaft. It discusses the anatomy of the forearm bones and the deforming forces that can occur with certain fracture locations. Types of fractures covered include isolated radius or ulna shaft fractures, both bone fractures, Monteggia fractures, Galeazzi fractures, and reverse Galeazzi fractures. Treatment options including nonoperative management with casting or operative management with open reduction and internal fixation are described. Postoperative rehabilitation and potential complications are also summarized.
Similar to Cervical spine injuries and its management (20)
Bone tumors can be benign or malignant. Benign tumors are encapsulated and compress surrounding tissue, while malignant tumors invade tissue and metastasize. Bone tumors are classified based on the type of tissue they form (e.g. bone, cartilage), their location in the bone, and whether they are primary or metastatic. Staging systems evaluate tumor grade, size, and spread to determine prognosis and guide treatment. Imaging including x-rays and MRI are used to identify tumor location, effects on bone, and presence of metastases to aid diagnosis.
This document discusses the biomechanics of the hip joint. It begins by defining biomechanics as the science examining forces acting on biological structures. It then describes the hip as both mobile and stable due to its strong bones, powerful muscles, and ligaments. The document goes on to discuss topics such as the femoral neck angle, acetabular version, muscles, joint reaction forces, gait biomechanics, and the effects of conditions like osteoarthritis. It concludes by covering the history and principles of hip biomechanics in total hip arthroplasty, including how procedures aim to decrease joint reaction forces.
This document discusses various angular deformities of the knee, including genu varum (bowlegged), genu valgus (knock-kneed), genu recurvatum, and genu procurvatum. It provides details on the causes, presentations, treatments, and assessments of genu varum and genu valgus. For genu varum, treatment may involve observation, bracing, or osteotomy, while genu valgus can be treated with observation, bracing, hemiepiphysiodesis, or osteotomy in more severe cases. Assessments involve measurements like intermalleolar distance and Q angle to evaluate deformities.
Legg-Calve-Perthes disease is a childhood condition caused by temporary loss of blood supply to the femoral head. It most commonly affects boys ages 4-8 and can cause deformity of the femoral head. Early containment of the femoral head via casts or surgery can prevent deformation and minimize long-term arthritis risk. Prognosis depends on the Herring classification, with surgery beneficial for lateral pillar group B/C cases after age 8. The goal of treatment is to maintain femoral head congruency and minimize secondary osteoarthritis.
Ewing sarcoma is a highly malignant bone tumor that most commonly affects children and young adults. It is characterized by small, round cancer cells of unknown origin that invade bone and sometimes spread to soft tissues or other bones. Diagnosis involves imaging tests and biopsy showing the characteristic cells. Treatment typically involves chemotherapy, surgery to remove the tumor if possible, and sometimes radiation therapy. While Ewing sarcoma has a poor prognosis if untreated, multidisciplinary treatment with chemotherapy, surgery, and radiation can result in 5-year survival rates of 60-75% for patients without metastasis at diagnosis.
Post traumatic myositis ossificans dr. k. prashanthPrashanth Kumar
This document discusses myositis ossificans, a condition where heterotopic bone forms in soft tissue, most often muscle, following trauma. Key points include:
- It is characterized by the development of mature bone in non-osseous tissues like muscle. Adolescents and young men are most commonly affected.
- Trauma is the most common precipitating factor. The pathogenesis involves cellular injury, necrosis, and proliferation of fibroblasts and mesenchymal cells that form bone.
- Radiographs show calcifications and ossification developing over weeks. Histopathology shows zones of ossification.
- Treatment involves rest, splinting, NSAIDs, and physical therapy to prevent loss of range
This document discusses microwave diathermy, which uses electromagnetic radiation between shortwave and infrared waves to generate heat deep in tissues for therapeutic purposes. It notes that microwave diathermy does not penetrate as deeply as shortwave diathermy due its higher frequency and shorter wavelength. The document provides details on microwave generators using 2450MHz frequency, applicators, absorption and penetration in different tissues, therapeutic effects, common applications for pain relief and increased circulation, as well as contraindications and treatment parameters.
Tarsal tunnel syndrome involves compression of the tibial nerve as it passes beneath the flexor retinaculum in the ankle. It causes pain, numbness and tingling in the foot. Non-surgical treatments include orthotics, stretching, weight loss and activity modification. Surgery to release the flexor retinaculum may be considered if non-surgical options fail. Anterior tarsal tunnel syndrome is a similar condition affecting the deep peroneal nerve. Risk factors include ankle injuries and activities that put repetitive stress on the ankle.
The document discusses viewing the knee as a biologic transmission with an envelope of function. It describes the various anatomic structures of the knee as parts of the transmission that accept, transfer, and dissipate loads. Factors like age, anatomy, kinematics, physiology, and treatment determine the envelope of function, or range of loads the knee can handle without failure. Conceptualizing the knee this way can help patients understand injuries and treatment in a more realistic way.
This document discusses various osteotomies around the hip joint, including their objectives, indications, and procedures. Proximal femoral and pelvic osteotomies are classified. Key points include that osteotomies are used to correct biomechanical alignment and load transmission across the hip joint. Procedures discussed in detail include Salter innominate osteotomy, Sutherland double innominate osteotomy, Steel triple innominate osteotomy, Ganz periacetabular osteotomy, and Pemberton osteotomy.
The document discusses the anatomy and physiology of lumbar intervertebral discs. It describes the normal structure and composition of discs, including the nucleus pulposus, annulus fibrosus, and endplates. Discs receive little blood supply and rely on diffusion for nutrition. With aging, discs undergo degeneration as proteoglycan content decreases, collagen content increases, and matrix turnover declines. This makes discs more prone to injuries like herniations and less able to function as effective shock absorbers.
Talus fractures involve the second largest tarsal bone. Hawkins classification system categorizes talus neck fractures into 4 types based on displacement and disruption of blood supply. Type 1 fractures are undisplaced while type 4 have the worst prognosis. Treatment depends on fracture type but generally involves anatomical reduction, stable fixation, and avoiding complications like avascular necrosis. Surgical approaches may be needed for types 2-4 to achieve and maintain reduction.
This document describes various surgical approaches to the knee joint. It begins by noting the knee is a hinge joint stabilized by muscles and ligaments. It then describes 7 open and 2 arthroscopic approaches. The medial parapatellar approach provides the most exposure and is commonly used for procedures like knee replacement. Arthroscopic approaches are now often preferred over open for treating conditions like meniscal tears. The document outlines principles for different surgical approaches and risks associated with various incisions near the knee.
This document provides information on claw hand deformities, including definitions, anatomy, classifications, evaluation, and surgical reconstruction techniques. It begins with defining claw hand as a flattening of the transverse metacarpal arch with hyperextension of the MCP joints and flexion of the PIP and DIP joints. It then discusses the anatomy and biomechanics involved in normal versus paralytic claw hands. Various classification systems for claw hands are presented based on etiology, pattern of nerve injury, degree of involvement, and physical characteristics. Evaluation techniques such as specific tests and angle measurements are outlined. Both static and dynamic surgical reconstruction methods are then described in detail, including tendon transfers, capsulotomies, and tenode
The document discusses the anatomy of the lower limb joints, including the hip, knee, and ankle joints. It describes the types of joints, articular surfaces, ligaments, movements, blood supply, clinical considerations, and gait for each joint. For the hip joint, it highlights the ball and socket construction, stability from muscles, ligaments and bone shape, and age-related diseases like osteoarthritis and fractures.
Diathermy uses electric currents to generate deep heat within tissues up to 2 inches below the skin's surface. It promotes blood flow and reduces pain and stiffness. Shortwave diathermy specifically uses radiofrequency currents between 10-100 MHz to heat tissues. It can treat musculoskeletal conditions like arthritis as well as injuries and infections by speeding recovery through increased circulation and metabolism. Risks include burns if not properly controlled or applied to people with medical implants. Proper electrode placement and settings are needed to target heating and avoid harming surrounding tissues.
This document provides information on the structure and function of various ligaments in the body. It begins by defining a ligament as a band of connective tissue that connects two bones or cartilages. It then discusses the histology and microstructure of ligaments. The document outlines the components and roles of several major ligaments including those in the knee (ACL, PCL), shoulder (coracohumeral), ankle (deltoid, lateral), and hip (iliofemoral, ischiofemoral, pubofemoral). It compares ligaments to tendons and describes ligament attachments and functions in stabilizing joints and absorbing shock.
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Still I Rise by Maya Angelou
-Table of Contents
● Questions to be Addressed
● Introduction
● About the Author
● Analysis
● Key Literary Devices Used in the Poem
1. Simile
2. Metaphor
3. Repetition
4. Rhetorical Question
5. Structure and Form
6. Imagery
7. Symbolism
● Conclusion
● References
-Questions to be Addressed
1. How does the meaning of the poem evolve as we progress through each stanza?
2. How do similes and metaphors enhance the imagery in "Still I Rise"?
3. What effect does the repetition of certain phrases have on the overall tone of the poem?
4. How does Maya Angelou use symbolism to convey her message of resilience and empowerment?
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2. • The cervical vertebrae are the smallest of the
moveable vertebrae, and are characterized by
a foramen in each transverse process.
• The first, second and seventh have special
features .
• The third, fourth and fifth cervical are almost
identical, and the sixth, while typical in its
general features, has minor distinguishing
differences.
5. • Readily identified by the foramen
transversarium perforating the transverse
processes. This foramen transmits the
vertebral artery, the vein,and sympathetic
nerve fibres
• Spines are small and bifid (except C1
and C7 which are single)
• Articular facets are relatively horizontal
6. • Nodding and lateral flexion movements occur
at the atlanto-occipital joint
• Rotation of the skull occurs at the atlanto-axial
joint around the dens, which acts as a pivot
7. MECHANISM OF INJURY
• Traction injury
• Direct injury: Penetrating injuries to the spine,
particularly from firearms and knives, are
becoming increasingly common
8. • Indirect injury: Most common cause. A variety of forces
may be applied to the spine (often simultaneously):
– axial compression flexion
– lateral compression
– flexion-rotation
– Shear
– flexion-distraction
– Extension
• Insufficiency fractures may occur with minimal force in
bone which is weakened by osteoporosis or a pathological
lesion
9. Mechanism of injury The spine is usually injured in
one of two ways: (a) a fall onto the head or the back of
the neck; and (b) a blow on the forehead, which forces
the neck into hyperextension
10. PRINCIPLES OF DIAGNOSIS AND
INITIAL MANAGEMENT
• Diagnosis and management go hand in hand
• Inappropriate movement and examination can
irretrievably change the outcome for the worse
• Early management
– Airway, Breathing and Circulation
– Slightest possibility of a spinal injury in a trauma
patient, the spine must be immobilized until the
patient has been resuscitated and other life-
threatening injuries have been identified and treated.
12. • If two or three columns
injured-lesion is unstable
• Works well for C3 to T1.
• Does not work so well for
C1-2, (so consider most or
all injuries here unstable)
• Only 10 per cent of spinal
fractures are unstable
• Less than 5 per cent are
associated with cord
damage
13. • A stable injury is one in which the vertebral
components will not be displaced by normal
movements;
• In a stable injury, if the neural elements are
undamaged there is little risk of them becoming
damaged.
• An unstable injury is one in which there is a
significant risk of displacement and consequent
damage – or further damage – to the neural
tissues.
14. RADIOLOGY
Alignment
Lateral view
Top of T1 visible
Three smooth arcs
maintained
Vertebral bodies of uniform
height
Odontoid intact and closely
applied to C1
15. AP View
• The height of the cervical
vertebral bodies should be
approximately equal
• The height of each joint
space should be roughly
equal at all levels
• Spinous process should be
in midline and in good
alignment
16. Odontoid View
• An adequate film should include
the entire odontoid and the lateral
borders of C1-C2.
• Occipital condyles should line up
with the lateral masses and
superior articular facet of C1.
• The distance from the dens to the
lateral masses of C1 should be
equal bilaterally.
• The tips of lateral mass of C1
should line up with the lateral
margins of the superior articular
facet of C2.
• The odontoid should have
uninterrupted cortical margins
blending with the body of C2.
23. Diagnostic pitfalls in children
• Children are often distressed and difficult to
examine;
• more than usual reliance may be placed on
the x-rays.
• It is well to recall some common pitfalls.
• An increased atlanto-dental interval (up to
4.5mm)
24. • may be quite normal; this is because the skeleton
is incompletely ossified and the ligaments
relatively lax during childhood.
• There may also be apparent subluxation of C2 on
C3 (pseudosubluxation).
• An increased retropharyngeal space can be
brought about by forced expiration during crying.
• Growth plates and synchondroses can be
mistaken for fractures..
25. • The normal synchondrosis at the base of the
dens has usually fused by the age of 6 years,
but it can be mistaken for an undisplaced
fracture.
• The spinous process growth plates also
resemble fractures; and the growth plate at
the tip of the odontoid can be taken for a
fracture in older children
26. • SCIWORA is an acronym for spinal cord injury
without obvious radiographic abnormality.
• Normal radiographs in children do not
exclude the possibility of spinal cord injury
FINDING OF FRACTURE, SUBLUXATION, OR
ABNORMAL INTERSEGMENTAL MOTION AT
LEVEL OF NEUROLOGICAL INJURY EXCLUDES
SCIWORA AS A DIAGNOSIS
27. • EXPERIMENTALLY, OSTEOCARTILAGINOUS
STRUCTURES IN SPINAL COLUMN CAN
STRETCH 2 INCHES WITHOUT DISRUPTION --
SPINAL CORD RUPTURES AFTER 1/4 INCH
• ANATOMICALLY, CERVICAL SPINAL CORD IS
RELATIVELY TETHERED - SPINAL NERVES,
DURAL ATTACHMENT TO FORAMEN
MAGNUM, AND BRACHIAL PLEXUS
28. • PRESENTING NEURO EXAM CORRELATES TO
OUTCOME
• MRI FINDINGS (OR LACK OF) MAY BE MORE
PREDICTIVE OF OUTCOME
• NO CHILD HAS BEEN DOCUMENTED TO
DEVELOP SPINAL INSTABILITY AFTER DX OF
SCIWORA
29. TREATMENT
• NO CONSENSUS:
BUT HARD COLLAR IMMOBILIZATION FOR 12
WEEKS AND AVOIDANCE OF FLEX/EXT
ACTIVITIES FOR ANOTHER 12 WEEKS HAS NOT
BEEN ASSOCIATED WITH RECURRENT INJURY
30. • PRINCIPLES OF DEFINITIVE
• TREATMENT
• The objectives of treatment are:
• • to preserve neurological function;
• • to minimize a perceived threat of
neurological compression;
• • to stabilize the spine;
• • to rehabilitate the patient
31. • The indications for urgent surgical
stabilization are:
• (a) an unstable fracture with progressive
neurological deficit and MRI signs of likely
further neurological deterioration; and
• (b) controversially an unstable fracture in a
patient with multiple injuries
32. Pharmacological Management
• Methylprednisolone sodium succinate (MPSS)
– Within 3 hours 30mg/kg bolus + 5.4mg/kg/hr
infusion for 24 hours.
– During 3~8 hours 30mg/kg bolus +
5.4mg/kg/hr infusion for 48 hours.
– suppress inflammatory response and vasogenic
edema
38. UPPER CERVICAL SPINE
• Occipital condyle fracture:
• This is usually a high-energy fracture and associated
skull or cervical spine injuries must be sought.
• The diagnosis is likely to be missed on plain x-ray
examination and CT is essential.
• Impacted and undisplaced fractures can be treated
by brace immobilization for 8–12 weeks.
. Displaced fractures are best managed by using a halo-
vest or by operative fixation.
39. • Occipito-cervical dislocation:
• This high-energy injury is almost always
associated with other serious bone and/or
soft-tissue injuries, including arterial and
pharyngeal disruption, and the outcome is
often fatal.
• Patients are best dealt with by a
multidisciplinary team of surgeons and
physicians.
40. • The diagnosis can sometimes be made on the
lateral cervical radiograph:
• the tip of the odontoid should be no more
than 5mm in vertical alignment and 1mm in
horizontal alignment from the basion (anterior
rim of the foramen magnum).
• Greater distances are allowable in children.
• CT scans are more reliable.
41. The injury is likely to be unstable and requires
immediate reduction (without traction!) and
stabilization with a halo-vest, pending surgical
treatment.
After appropriate attention to the more serious
softtissue injuries and general resuscitation, the
dislocation should be internally fixed;
specially designed occipito-cervical plates and screws
are available for the purpose.
In severely unstable injuries, halo-vest stabilization
should be retained for another 6–8 weeks.
42. Occipito–cervical fusion X-ray showing one of
the devices used for internal fixation in occipito-cervical
fusion operations
43. • C1 ring fracture:
• Sudden severe load on the top of the head may cause
a ‘bursting’ force which fractures the ring of the atlas
(Jefferson’s fracture).
There is no encroachment on the neural canal and,
usually, no neurological damage.
• The fracture is seen on the open-mouth view (if the
lateral masses are spread away from the odontoid peg)
and the lateral view.
• A CT scan is particularly helpful in defining the fracture.
45. • If it is undisplaced, the injury is stable and the
patient wears a semi-rigid collar or halo-vest until
the fracture unites.
• If there is sideways spreading of the lateral
masses (more than 7 mm on the open-mouth
view), the transverse ligament has ruptured;
• this injury is unstable and should be treated by a
halo-vest for several weeks.
• If there is persisting instability on x-ray, a
posterior C1/2 fixation and fusion is needed.
46. • A hyperextension injury can fracture either
the anterior or posterior arch of the atlas.
• These injuries are usually relatively stable and
are managed with a halo-vest or semi-rigid
collar until union occurs.
• Fractures of the atlas are associated with
injury elsewhere in the cervical spine in up to
50 per cent of cases.
47. • C2 pars interarticularis fractures:
• In the true judicial ‘hangman’s fracture’ there
are bilateral fractures of the pars
interarticularis of C2 and the C2/3 disc is torn;
• the mechanism is extension with distraction.
• In civilian injuries, the mechanism is more
complex, with varying degrees of
extension,compression and flexion.
48. • This is one cause of death in motor vehicle
accidents when the forehead strikes the
dashboard.
• Neurological damage, however, is unusual
because the fracture of the posterior arch
tends to decompress the spinal cord.
• Nevertheless the fracture is potentially
unstable
50. • Undisplaced fractures which are shown to be
stable on supervised flexion–extension views
(less than 3mm of C2/3 subluxation) can be
treated in a semi-rigid orthosis until united
(usually 6–12 weeks).
51. • Fractures with more than 3mm displacement but
no kyphotic angulation may need reduction;
• however, because the mechanism of injury
usually involves distraction, traction must be
avoided.
• After reduction, the neck is held in a halo-vest
until union occurs. C2/3 fusion is sometimes
required for persistent pain and instability
(‘traumatic spondylolisthesis’).
52. • Occasionally, the ‘hangman’s fracture’ is
associated with a C2/3 facet dislocation.
• This is a severely unstable injury; open
reduction and stabilization is required
53. C2 Odontoid process fracture
• Odontoid fractures are uncommon.
• They usually Occur as flexion injuries in
young adults after highvelocity injuries.
• However, they also occur in elderly,
osteoporotic people as a result of low-energy
trauma in which the neck is forced into
hyperextension, e.g. a fall onto the face or
forehead
54. • A displaced fracture is really a fracture-
dislocation of the atlanto-axial joint in which the
atlas is shifted forwards or backwards, taking the
odontoid process with it.
• At this level about a third of the internal
diameter of the atlas is free space, a third filled
with the odontoid and a third with the cord;
• thus there is room for displacement without
neurological injury.
• However,cord damage is not uncommon and in
old people there is a considerable mortality rate
55. Classification
• • Type I – An avulsion fracture of the tip of
the odontoid process due to traction by the
alar ligaments.
• The fracture is stable (above the transverse
ligament) and unites without difficulty.
• .
56. • • Type II – A fracture at the junction of the
odontoid process and the body of the axis.
• This is the most common (and potentially the
most dangerous) type.
• The fracture is unstable and prone to non-
union
57. • • Type III – A fracture through the body of
the axis.
• The fracture is stable and almost always unites
with immobilization.
58. Fractured odontoid process (a) Anteroposterior
‘open-mouth’ x-ray showing a Type II odontoid fracture.
(b) Lateral x-ray of the same patient.
59. • Clinical features
• The history is usually that of a severe neck strain
followed by pain and stiffness due to muscle spasm.
• The diagnosis is confirmed by high quality x-ray
examination;
• it is important to rule out an associated occipito-
cervical injury which commands immediate attention.
In some cases the clinical features are mild and
continue to be overlooked for weeks on end.
• Neurological symptoms occur in a significant number
of cases.
60. • Imaging
• Plain x-rays usually show the fracture, although
the extent of the injury is not always obvious –
e.g. there may be an associated fracture of the
atlas or displacement at the occipito-atlanto
level.
• Tomography is helpful but MRI has the advantage
that it may reveal rupture of the transverse
ligament; this can cause instability in the absence
of a fracture.
61. • Treatment
• Type I fractures Isolated fractures of the
odontoid tip are uncommon.
• They need no more than immobilization in a
rigid collar until discomfort subsides.
62. • Type II fractures These are often unstable and
prone to non-union, especially if displaced more
than 5 mm.
• Undisplaced fractures can be held by fitting a
halo-vest or – in elderly patients – a rigid collar.
• Displaced fractures should be reduced by traction
and can then be held by operative posterior C1/2
fusion; a drawback is that neck rotation will be
restricted.
63. • Anterior screw fixation is suitable for Type II
fractures that run from anterior-superior to
posterior-inferior,provided the fracture is not
comminuted, that the transverse ligament is not
ruptured, that the fracture is fully reduced and
the bone solid enough to hold a screw; in that
case neck rotation is retained.
• If full operative facilities are not available,
immobilization can be applied by using a halo-
vest with repeated x-ray monitoring to check for
stability.
64. Fractured odontoid – treatment (a) A severely displaced Type II odontoid fracture. (b)
The fracture was reduced
by skull traction and held by fixing the spinous process of C1 to that of C2 with wires. (c)
An undisplaced Type II fracture,
which was suitable for (d) anterior screw fixation.
65. • Type III fractures If undisplaced, these are treated in a
halo-vest for 8–12 weeks.
• If displaced, attempts should be made at reducing the
fracture by halo traction, which will allow positioning in
either flexion or extension, depending on whether the
displacement is forward or backward;
• the neck is then immobilized in a halo-vest for 8–12
weeks.
• For elderly patients with poor bone a collar may
suffice, though this carries a higher risk of non-union.
66. LOWER CERVICAL SPINE
• Fractures of the cervical spine from C3 to C7
tend to produce characteristic fracture
patterns, depending on the mechanism of
injury:
• flexion,
• axial compression,
• flexion–rotation or
• hyperextension
67. Posterior ligament injury
• Sudden flexion of the mid-cervical spine can
result in damage to the posterior ligament
complex (the interspinous ligament, facet
capsule and supraspinous ligament).
• The upper vertebra tilts forward on the one
below, opening up the interspinous space
posteriorly
68. Cervical spine – posterior ligament injury
(a) The film taken in extension shows no displacement of
the vertebral bodies, but there is an unduly large gap
between the spinous processes of C4 and 5. (b) With the
neck slightly flexed the subluxation is obvious.
NB: flexion–extension views are potentially dangerous and
should be used only in specific situations under direct
supervision of an experienced surgeon.
69. • The patient complains of pain and there may
be localized tenderness posteriorly.
• X-ray may reveal a slightly increased gap
between the adjacent spines;
• however, if the neck is held in extension this
sign can be missed, so it is always advisable to
obtain a lateral view with the neck in the
neutral position
70. • . A flexion view would, of course, show the
widened interspinous space more clearly, but
flexion should not be permitted in the early
post-injury period.
• This is why the diagnosis is often made only
some weeks after the injury,when the patient
goes on complaining of pain.
71. • The assessment of stability is essential in these
cases.
• If the angulation of the vertebral body with its
neighbour exceeds 11 degrees, if there is anterior
translation of one vertebral body upon the other
of more than 3.5 mm or if the facets are fractured
or displaced, then the injury is unstable and it
should be treated as a subluxation or dislocation.
•
72. • If it is certain that the injury is stable, a semi-
rigid collar for 6 weeks is adequate;
• if the injury is unstable then posterior fixation
and fusion is advisable
73. Wedge compression fracture
• A pure flexion injury results in a wedge
compression fracture of the vertebral body
• The middle and posterior elements remain
intact and the injury is stable.
• All that is needed is a comfortable collar for 6–
12 weeks.
74. • A note of warning: The x-ray should be
carefully examined to exclude damage to the
middle column and posterior displacement of
the vertebral body fragment, i.e. features of a
burst fracture (see below)which is potentially
dangerous. If there is the least doubt, an axial
CT or MRI should be obtained
75. Cervical compression fracture A wedge
compression
fracture of a single cervical vertebral body. This
is
a stable injury because the middle and
posterior elements
are intact.
76. Burst and compression-flexion (‘teardrop’)
fractures
• These severe injuries are due to axial compression of
the cervical spine, usually in diving or athletic accidents
• If the vertebral body is crushed in neutral position of
the neck the result is a ‘burst fracture’.
• With combined axial compression and flexion,an
antero-inferior fragment of the vertebral body is
sheared off, producing the eponymous ‘tear-drop’ on
the lateral x-ray.
• In both types of fracture there is a risk of posterior
displacement of the vertebral body fragment and
spinal cord injury.
77. • Plain x-rays show either a crushed vertebral body
(burst fracture) or a flexion deformity with a triangular
fragment separated from the antero-inferior edge of
the fractured vertebra (the innocent-looking
‘teardrop’).
• The x-ray images should be carefully examined for
evidence of middle column damage and posterior
displacement (even very slight displacement) of the
main body fragment.
• Traction must be applied immediately
• and CT or MRI should be performed to look for
retropulsion of bone fragments into the spinal canal.
78. • TREATMENT
• If there is no neurological deficit, the patient
can be treated surgically or by confinement to
bed and traction for 2–4 weeks, followed by a
further period of immobilization in a halo-vest
for 6–8 weeks. (The halo-vest is unsuitable for
initial treatment because it does not provide
axial traction).
79. • If there is any deterioration of neurological
status while the fracture is believed to be
unstable, and the MRI shows that there is a
threat of cord compression,then urgent
anterior decompression is considered anterior
corpectomy, bone grafting and plate fixation,
and sometimes also posterior stabilization.
80. Tear-drop fracture (a) This comminuted vertebral body fracture has produced a large
anterior fragment and obvious
posterior displacement of the posterior fragment. (b) In this case the anterior ‘tear-
drop’ was noted but the severity of
the injury was underestimated; careful examination shows that the main body fragment
is displaced slightly posteriorly.
The patient was treated in a collar; 3 weeks later (c) the fracture had collapsed and the
large body fragment was now
very obviously tilted and displaced posteriorly. By then he was complaining of tingling
and weakness in his right arm.
Beware the innocent tear-drop!
81. Hyperextension injury
• Hyperextension strains of soft-tissue
structures are common and may be caused by
comparatively mild acceleration forces. Bone
and joint disruptions, however,are rare.
• The more severe injuries are suggested by the
history and the presence of facial bruising or
lacerations.
• The posterior bone elements are compressed
and may fracture;
82. • the anterior structures fail in tension, with
tearing of the anterior longitudinal ligament
or an avulsion fracture of the anterosuperior
or anteroinferior edge of the vertebral body,
opening up of the anterior part of the disc
space, fracture of the back of the vertebral
body and/or damage to the intervertebral disc
83. • . In patients with pre-existing cervical
spondylosis, the cord can be pinched between
the bony spurs or disc and the posterior
ligamentum flavum;
• oedema and haematomyelia may cause an
acute central cord syndrome (quadriplegia,
sacral sparing and more upper limb than
lower limb deficit,a flaccid upper limb
paralysis and spastic lower limb paralysis).
84. • These injuries are stable in the neutral
position, in which they should be held by a
collar for 6–8 weeks.
• Healing may lead to spontaneous fusion
between adjacent vertebral bodies
85. Hyperextension injuries (a) The anterior longitudinal ligament has been torn; in the
neutral position the gap will
close and reduction will be stable, but a collar or brace will be needed until the soft
tissues are healed. (b) X-ray in this
case showed a barely visible flake of bone anteriorly at the C6/7 disc space. (c) 1
month later the traction fracture at C6/7
was more obvious, as was the disc lesion at C5/6. (d) A year later C6/7 has fused
anteriorly; the patient still has neck pain
due to the C5/6 disc degeneration.
86. Avulsion injury of the spinous process
• Fracture of the C7 spinous process may occur
with severe voluntary contraction of the
muscles at the back of the neck; it is known as
the clay-shoveller’s fracture.
• The injury is painful but harmless.
• No treatment is required;
• as soon as symptoms permit, neck exercises
are encouraged.
87. Avulsions (a) The clay-shoveller’s fracture.
Jerking the neck backwards has resulted
in avulsion of one of the spinous processes – a
benign injury. (b) This patient might be
thought to have a similar fracture, but a subsequent
flexion film (c) shows the serious nature
of the injury – a severe fracture-dislocation
88. SPRAINED NECK (WHIPLASH INJURY)
• Soft-tissue sprains of the neck are so common
aftermotor vehicle accidents that they now constitute
a veritable epidemic.
• There is usually a history of a lowvelocity rear-end
collision in which the occupant’s body is forced against
the car seat while his or her head flips backwards and
then recoils in flexion.
• This mechanism has generated the imaginative term
whiplash injury, which has served effectively to
enhance public apprehension at its occurrence.
• .
89. • However, similar symptoms are often reported
with flexion and rotation injuries.
• Women are affected more often than men,
perhaps because their neck muscles are more
gracile
90. • There is disagreement about the exact pathology
but it has been suggested that the anterior
longitudinal ligament of the spine and the
capsular fibres of the facet joints are strained and
in some cases the intervertebral discs may be
damaged in some unspecified manner.
• There is no correlation between the amount of
damage to the vehicle and the severity of
complaints.
93. Clinical features
• Often the victim is unaware of any abnormality
immediately after the collision.
• Pain and stiffness of the neck usually appear within the
next 12–48 hours, or occasionally only several days later.
• Pain sometimes radiates to the shoulders or interscapular
area and may be accompanied by other, more ill-defined,
symptoms such as headache, dizziness, blurring of vision,
paraesthesia in the arms, temporomandibular discomfort
and tinnitus.
• Neck muscles are tender and movements often restricted;
the occasional patient may present with a ‘skew neck’.
Other physical signs – including neurological defects – are
uncommon.
94. • X-ray examination may show straightening out
of the normal cervical lordosis, a sign of
muscle spasm; in other respects the
appearances are usually normal.
• In some cases, however, there are features of
longstanding intervertebral disc degeneration
or degenerative changes in the uncovertebral
joints; it may be that these patients suffer
more, and for longer spells,than others.
95. • Proposed grading of whiplash-associated
• injuries
• Grade Clinical pattern
• 0 No neck symptoms or signs
• 1 Neck pain, stiffness and tenderness No physical
signs
• 2 Neck symptoms and musculoskeletal signs
• 3 Neck symptoms and neurological signs
• 4 Neck symptoms and fracture or dislocation
96. Differential diagnosis
• The diagnosis of sprained neck is reached largely
by a process of exclusion, i.e. the inability to
demonstrate any other credible explanation for
the patient’s symptoms.
• X-rays should be carefully scrutinized to avoid
missing a vertebral fracture or a mid-cervical
subluxation.
• The presence of neurological signs such as muscle
weakness and wasting, a depressed reflex or
definite loss of sensibility should suggest an acute
disc lesion and is an indication for MRI.
97. • Seat-belt injuries often accompany neck sprains.
• They do not always cause bruising of the chest,
but they can produce pressure or traction injuries
of the suprascapular nerve or the brachial plexus,
either of which may cause symptoms resembling
those of a whiplash injury.
• The examining doctor should be familiar with the
clinical features of these conditions.
98. Treatment
• Collars are more likely to hinder than help recovery.
• Simple pain-relieving measures, including analgesic
medication, may be needed during the first few weeks.
• However, the emphasis should be on graded exercises,
• beginning with isometric muscle contractions and
postural adjustments, then going on gradually to active
movements and lastly movements against resistance.
• The range of movement in each direction is slowly
increased without subjecting the patient to
unnecessary pain. Many patients find osteopathy and
chiropractic treatment to be helpful.
99. • 1-5% OF CSI ARE MISSED - MAINTAIN
APPROPRIATE LEVEL OF SUSPICION IF SEEING A
PATIENT WITH CONTINUED NECK PAIN AFTER
BEING “CLEARED” -- KNOW THE BASIC
MANAGEMENT GUIDELINES FOR CLEARING THE
C-SPINE
• If a spinal fracture is identified at any level, the
entire spine should be examined with antero-
posterior and lateral views to document the
presence or absence of spinal fractures at other
levels
TAKE HOME MESSAGE
100. • MISSED/DELAYED CSI OCCURS DUE TO
LACK OF AN APPROPRIATE INDEX OF
SUSPICION, INADEQUATE PLAIN FILMS, AND
MISREAD STUDIES
• IF HAVE HIGH ENOUGH INDEX OF SUSPICION
TO GET XRAYS, THEN DO NOT ACCEPT
INADEQUATE ONES
101. • IN “CLEARING” THE C-SPINE, DO NOT FORGET
NONSKELETAL INJURIES: LIGAMENTOUS
INSTABILITY, CERVICAL STENOSIS, AND
SCIOWRA
• KNOW YOUR PEDIATRIC ANATOMICAL
VARIATIONS
• DON’T BE IN A HURRY TO CLEAR THE
CERVICAL SPINE - CAN ALWAYS LEAVE IN A
HARD COLLAR
102. • Progressive neurological deficit in cord
compression needs early surgical
decompression.
• Anterior decompression is better.
• Early surgical intervention for instability
prevents deterioration